Big drop in state AIDS deaths

Deaths from AIDS in California have plummeted, falling 60.1 percent in one year, state health officials said Friday.

San Francisco followed the trend, showing a marked decline in the first half of last year in the number of deaths among people with AIDS.

The Department of Health Services said the decline was due to a slowing in the rate of new HIV infections and improved treatments with potent new drugs, which have extended the average time - now more than 10 years - between infection with HIV and the onset of illness.

State epidemiologists estimated that 1,112 people died of AIDS in the first half of 1997, down from 2,788 in the first half of 1996.

From the peak of the state epidemic in 1994, the death rate has fallen 72.1 percent.

During the same period, 297 San Franciscans died of the disease. In the first half of the previous year, 639 San Franciscans died of AIDS.

The peak number of AIDS deaths in San Francisco - 830 - was reported between January and June of 1992.

A similar decline in deaths has been reported elsewhere in North America, in cities as diverse as Vancouver and New York. But outside the United States, the death toll is accelerating: Nearly a quarter of the 6.4 million AIDS deaths occurred in the last year, according to the World Health Organization.

The drop in deaths coincides with the introduction of a potent new class of anti-viral drugs called protease inhibitors and expansion of efforts such as California's AIDS Drug Assistance Program.

Experts also attribute the decline to broadened access to effective treatment and care. The federal government has boosted funding of the Ryan White CARE Act, offering patients access to better care and treatment of often-fatal opportunistic infections.

The drop also reflects decreases in HIV infections among gay and bisexual men and injecting drug users that occurred more than a decade ago. The number of new deaths are only now reflecting this change because of the incubation period between HIV infection, AIDS and death.

Because of the decline in the number of AIDS deaths, the number of people living with AIDS in the state has increased.

"With more people living with AIDS, we will need to maintain our array of community services and some costs - such as those for drug therapy and outpatient medical care - will actually increase, rather than decrease. Clearly, continued funding is needed," Dr. Mitchell Katz of the San Francisco AIDS Office said recently.

The declining U.S. death rate is no signal to let up on efforts to treat the infected and educate people to avoid contracting the virus. Barring a scientific breakthrough, the task of containing the threat will be a major one for decades.

There is yet no cure: recent scientific studies suggest that anti-HIV drugs that lower the virus to undetectable levels leave a silent infection in patients' immune systems that can rebound dangerously if the expensive treatment is ever stopped.

Scientists have found evidence of the virus hiding in

"resting cells" of the immune system - white blood cells known as CD4 T-cells, according to Dr. Anthony Fauci, director of the National Institute of Allergy and Infectious Diseases.

Implications of the declining death rate include the fact that more people are living longer with AIDS and putting greater demands on treatment facilities and other forms of support.

Moreover, the populations affected by HIV are increasingly poor, heterosexual minorities, intravenous drug users, and women, most of whom have not been able to obtain private insurance coverage to pay for their expensive anti-viral therapy and monitoring.

Fewer than one in five people with HIV are covered by private health insurance. The rest depend either on public assistance - or have no insurance at all.&lt;